Current Procedural Terminology (CPT®) Codes: An Overview

Current Procedural Terminology, or CPT, is a set of medical codes that categorize medical procedures. Doctors, health insurance companies and accreditation organizations use these codes when notating or collecting data about procedures. CPT codes were developed as a uniform coding system to help providers, such as physicians’ offices and hospitals, accurately submit claims to request reimbursement from payers including insurance companies, Medicaid and Medicare after they’ve provided medical, surgical or diagnostic services.

Anyone who works with medical codes within the United States, like physicians or medical billers and coders, should know CPT codes. If you plan to work in medical billing and coding specifically, you will need to learn CPT codes and become familiar with how to navigate the Current Procedural Terminology database to accurately assign codes to the various procedures that happen in your care facility. Learning CPT codes is a standard part of medical billing and coding training.

You also need a working knowledge of CPT codes to pass the Certified Professional Coder (CPC) exam and other certification exams within the medical billing and coding field. A knowledge of CPT may also be helpful if you’re working in hospital management or healthcare administration, as you will likely interact with some billing information.

Current Procedural Terminology codes are updated on an annual basis. The CPT editorial panel, made up of 21 medical professionals, meets three times a year to review applications for new codes and discuss revisions to existing ones. Approved codes then go into effect beginning January 1st of the following year.

As a code system, CPT codes are broken up into categories. Each category represents a different set of procedures and codes. Here’s a quick breakdown showing what each category is used for and what procedures or devices they represent:

Category 1 codes correspond to procedures or services. For example, a surgical procedure would fall under Category 1. The codes within this category range from 00100 to 99499. These numeric codes are then further ordered into individual subcategories based on anatomy and procedure type.

Category 2 codes are supplemental codes that are attached to a Category 1 code and are used to specify performance measures. These codes are alphanumeric, making it easier to attach them to existing Category 1 codes.

Category 3 codes are used to represent new and emerging technologies, procedures and services. They are primarily used for data collection, assessment and procedures that do not yet meet the criteria for a Category 1 code.

PLA codes are a recent addition to the CPT codes. In a way, they are similar to Category 3 codes but are specifically for services and technologies that may belong to either a single care facility, doctor or laboratory, or that may be marketed to multiple labs that are approved by the FDA.

Among the most frequently used CPT codes are:

What’s the difference between a CPT code and an ICD code? The primary difference between the two sets of codes is that they have different purposes. They are also managed by two different governing bodies. CPT codes identify the healthcare services that have been provided to a patient. The CPT code system is managed by the American Medical Association. The ICD code system is used to identify diagnoses and is managed by the World Health Organization. ICD-10, or the 10^th revision of the ICD system, was introduced in 2019.

Medical coding modifiers are used to provide a more complete description of the care a patient has received by including more detail about a medical procedure, service or supply that has been provided without changing the meaning of the original code. For example, a modifier might be used to specify the anatomical location of a medical procedure. In the case of CPT codes, they appear as two letters or numbers that follow the basic 5-digit code.

Here’s an example of how CPT code modifiers are used:

A surgeon has performed a procedure to remove a bone cyst in a patient’s upper arm and the procedure also included obtaining a graft from another area of the patient’s body, but minor complications prevented the surgeon from fully excising the bone cyst.

For this procedure, the coder would use code 23140 for the excision of the bone cyst, then add the modifier “52” for reduced services. So the resulting complete code would be 23140-52.